The nutritional status of the elderly has been studied extensively, but little is known about the problematic eating behavior of nursing home residents that may result in dehydration, malnutrition, weight loss, and eventually placement of a feeding tube. The purpose of this 4 year anthropological study is to investigate eating problems and the use of feeding tubes in 2 nursing homes. The specific aims are to identify, describe, and analyze: 1) The social, cultural, and environmental factors (e.g., ethnicity, marital status and dining room conditions) that influence eating behavior; 2) Resident characteristics such as age and mental and physical status, that affect eating behavior; 3) The process of evaluating and managing eating problems (what happens over time to patients with eating problems; 4) The social-cultural factors that influence the decision to give or withhold tube feedings (e.g., given similar conditions, why are some tube-fed while others are not); 5) The consequences (social and cultural) of tube feedings for patients and families; 6) Families' and caregivers' (e.g., physicians and nurses) perception of eating problems and tube feeding; and 7) The process of enteral feeding (e.g., who gives the feeding, how, when, and where are they given, and position of patient during and after feeding). This qualitative research uses three strategies: Participant observation, in-depth interviews with 75 patients, families, nursing staff, and physicians (N=200, 1/2 in each of two settings), and event analysis which will be used to describe prospectively three groups: 1) patients with eating problems that are resolved, 2) patients with continuing eating problems who are not tube-fed, and 3) patients with eating problems who eventually are tube-fed. In each setting, 50 subjects (N=100) will be followed for 6 months to obtain a natural history of patients with eating problems documenting: a) factors that influence eating behavior and the decision to insert a feeding tube; b) the process of evaluating and managing eating problems; and c) the consequences of feeding tubes for patients and their families. This research will extend the body of knowledge theoretically in the areas of labeling and decision-making theory and in the applied area of eating problems and the use of feeding tubes in nursing homes. Findings may suggest interventions that will improve the quality of life of nursing home residents.